How to make a pharmacy claim

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Want to learn more about how and when you can make a pharmacy claim? 

We’re here for you, spoonful of sugar at hand to make the medicine go down.

Last month we told you the important information you need on any extras receipt so that you can claim it on your Peoplecare extras cover (in case you missed it, here’s the link). This is the same info we’ll need for a pharmacy claim to be paid. So, let’s take the opportunity to recap:

Peoplecare needs the following details on your pharmacy receipt:

  • Patient’s name
  • Pharmacy’s details
  • Medication name & script details
  • Dispense date
  • Amount paid

 

Which medicines can I claim?*

Peoplecare can only pay a benefit on medicines that are:

  • above the PBS co-payment amount ($40.30 as of September 2019);
  • approved by the Therapeutic Goods Administration;
  • not excluded by the health fund (e.g. contraceptives, for instance); 
  • prescription only (i.e. unavailable over the counter); and
  • less than two years old.

The types of medications members typically claim through Peoplecare are immunisations (for instance, the shots you get before you travel) and the many drugs that have been deemed safe by the Therapeutic Goods Administration but haven’t yet made it on to the PBS.

*Peoplecare provides benefits towards pharmacy on all of its extras covers. 

 

How does a pharmacy claim payment work?

An eligible pharmacy claim might look like this example for someone who hasn’t yet used any of their annual limit:

Medicine cost = $110

minus PBS co-payment amount before calculating benefit = $69.70 

 

 

Simple Extras

Mid Extras

High Extras

Premium Extras

Benefit rate

50% to $50

60% to $60

70% to $70

80% to $80

Annual limit

$200 per person

$400 per family

$300 per person

$600 per family

$400 per person

$800 per family

$500 per person

$1,000 per family

Example benefit

$34.85

$41.82

$48.79

$55.76

 

To claim for pharmacy, send your full pharmacy receipt to us via our appOnline Member Services, by email (along with a claim form) or by post (to Peoplecare, Locked Bag 33, Wollongong NSW 2500).